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Head nodding associated with intermittent esotropia.

S E Rubin¹, M L Slavin

¹Department of Ophthalmology, Long Island Jewish Medical Center, New Hyde Park, NY 11042.

Journal of Pediatric Ophthalmology and Strabismus

|September 1, 1990

Summary

Head nodding in infants can signal neurological issues or spasmus nutans. This study found head nodding may help maintain fusion in neurologically normal infants with intermittent esotropia.

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Area of Science:

Neurology
Ophthalmology
Pediatrics

Background:

Head nodding, or torticollis, is often associated with abnormal eye movements like nystagmus.
In neurologically normal individuals, head nodding without nystagmus may indicate underlying neurological conditions such as cerebellar disease or basal ganglia dysfunction.

Observation:

A neurologically normal infant presented with intermittent head nodding and intermittent esotropia.
Head movements occurred only when the infant's eyes were aligned and ceased upon eye occlusion or the onset of esotropia.
Forcible stabilization of the infant's head induced immediate esotropia.

Findings:

The infant's head nodding appeared to facilitate binocular fusion, a process where the brain combines images from both eyes.
The head movements ceased when fusion was disrupted by eye occlusion or the spontaneous development of esotropia.
The mechanism by which head nodding aids fusion in this context remains unclear.

Implications:

This case suggests that head nodding in infants, even without nystagmus, may serve a compensatory role in maintaining binocular vision.
Further research is needed to elucidate the precise mechanism and clinical significance of head nodding as a fusion aid in pediatric ophthalmology.
Understanding this phenomenon could lead to novel diagnostic or therapeutic approaches for certain types of strabismus in infants.

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